6.2 Health Screening, Illness Reporting and Exclusion

The Health Screening Questionnaire

Key idea: Every individual completes a health screening questionnaire before the training and assessment, declaring six illnesses from the preceding 12 months. A declaration is not a ban — but it does trigger a mandatory medical clearance before you can be registered.

Registration for National Water Hygiene on EUSR is not automatic on passing the assessment. A health screening questionnaire must be completed by all individuals prior to the training and assessment. Two features of that sentence carry assessment weight. First, the timing: the questionnaire comes before the course, not after it. Second, the coverage: all individuals — there is no exemption for experienced operatives, subcontractors or Self-Lay Organisation personnel, just as the Blue Card requirement itself applies to everyone working on Restricted Operations.

In the questionnaire, you must declare whether you have, or have had in the preceding 12 months, any of these illnesses:

• typhoid;
• paratyphoid;
• dysentery;
• persistent diarrhoea or vomiting;
• jaundice or hepatitis (A or E);
• prolonged unexplained fever.

Look carefully at the shape of that list, because two details are regularly tested. The 12-month look-back means the question is not just about how you feel on the day of the course. And the list deliberately mixes named diseases with symptoms: persistent diarrhoea or vomiting, jaundice and prolonged unexplained fever are things you experience, not things a laboratory has to confirm before the duty applies.

What a Declaration Triggers

If you have, or have had, any of these illnesses, then you must get written confirmation from a medical practitioner — for example your GP — that you are illness and symptom free before you can be registered for National Water Hygiene on EUSR. Three points to hold onto:

• It must be written. A verbal all-clear from a supervisor, a pharmacist or your own sense of having recovered does not satisfy the requirement.
• It must come from a medical practitioner. The example EUSR gives is your GP.
• It gates registration. The Blue Card is withheld until the written clearance exists. This is not an optional extra, and it is not at the discretion of the trainer or the employer.

Why These Six Illnesses Are on the List

The common thread is the faecal-oral route from the earlier disease chapters. What unites a typhoid carrier, a person recovering from dysentery and someone with an unexplained fever is that each could shed organisms into potable water while feeling largely well — which is precisely what the clearance step is designed to rule out.

Your Duty Does Not End at Registration

The questionnaire is the entry gate, but the responsibility runs for as long as you hold the card. If you suffer diarrhoea, vomiting or any of the listed illnesses while registered:

1. Report it to your employer and the site controller — promptly, before your next shift on Restricted Operations, not after it.
2. Come off Restricted Operations and stay off until you are cleared to return.
3. Do not return on your own judgement. UKHSA guidance on gastrointestinal illness is to stay off work until at least 48 hours after symptoms have stopped — UKHSA's norovirus guidance says exactly this, and UKHSA public advice on Cryptosporidium (on gov.uk) likewise says not to return to work until free from diarrhoea and vomiting for 48 hours. The reason is shedding: you remain infectious after you feel better.

The 48-hour figure is a typical minimum, and an employer's policy or a medical practitioner's advice can extend it — for example where a diagnosis such as typhoid is confirmed.

Why Persistent Diarrhoea Matters Without a Diagnosis

You do not need to know what an illness is for it to be reportable. Persistent diarrhoea or vomiting is on the list as a symptom, precisely because waiting for a diagnosis delays exclusion while the organism spreads. The same logic covers the fever entry: unexplained, but listed. Nor is feeling better the all-clear — recall from the disease chapters that typhoid carriers can shed the bacteria for months after symptoms resolve, without feeling unwell at all. Symptomless shedding is the reason the medical clearance exists and the reason self-certification does not.

What the Site Controller Does With Your Declaration

A declaration is handled as a risk control, not a disciplinary matter. The site controller records it, takes you off clean-side duties, and reassigns you to work with no potable water contact where possible. Where an illness is confirmed or prolonged, the return to Restricted Operations is agreed with occupational health or your GP, and the record supports the company's duty to protect both the public and its workforce. Reporting protects you: the worker who reports promptly is complying with the scheme; the worker who hides a bug is the cause of the next incident.

The Danger of Working Through a Bug

In most jobs, a 24-hour stomach bug is an inconvenience you work through. On Restricted Operations the same decision is a contamination event waiting to happen: vomiting near an open chamber, soiled clothing, hands that cannot be trusted, and an organism still being shed for at least 48 hours after you feel fine. One unreported bug can contaminate a main serving thousands of customers, trigger boil-water notices and expose the company to enforcement by the Drinking Water Inspectorate. Exclusion protects the public — and it protects the company and your own registration.

Site Scenario: A Groundworker on a Main-Laying Job

A groundworker is two days into a main-laying contract and develops vomiting overnight. The correct sequence: stay at home rather than travelling to site; report to the employer and site controller first thing by phone; come off Restricted Operations immediately; and remain off clean-side work until cleared — in line with UKHSA guidance, at least 48 hours after the symptoms stop, and longer if the employer's policy or a medical practitioner requires it. When he returns, it is with clean clothing, a fresh declaration if the illness is one of the six, and no sense of having done anything other than the professional thing.

Common Exam Traps

• The questionnaire is only for new applicants. It must be completed by all individuals prior to the training and assessment — and the duty to report illness continues for as long as you hold the registration.
• A mild upset stomach is not reportable. Persistent diarrhoea or vomiting is a listed entry in its own right; grading the severity is not the worker's judgement to make.
• Only diagnosed illnesses count. Three of the six entries — persistent diarrhoea or vomiting, jaundice, prolonged unexplained fever — are symptoms. No laboratory diagnosis is needed to trigger the duty.